Wednesday, December 19, 2007

Fourth and final bullet is "Dye Test" - this refers to the HSG dye test my wife had done at Dr. S's urging to check for fallopian tube blockage. There are two separate pieces of paper in our files from Dr. S's office. One states something like "Left tube fills and spills. Right tube fills, but does not spill." (apologies for not providing verbatim, but I don't have the file with me right now) The second states "Left tube fills and spills. Right tube fills, and subsequently spills." I remember reading these notes after the procedure was done, but I had no idea if it indicated a problem or not. Dr. S. told us there was no issue, as did the Doctors who conducted the procedure, so we figured we were good to go. Dr. M., however, was a bit confused by the contradicting messages in this documentation - he could only ascertain that there may have been some disagreement between the two people conducting the procedure, or that the procedure might not have been done correctly. Perhaps this is part of the problem in switching clinics - a lot of information is lost in translation. Either way, this seems to be another area, however slight, of less than optimal clarity into the details of our procedure with Dr. S. - as noted in my last post, this bullet is not such a big deal and I really don't think there is any blame to be placed - but the fact is, based on the documentation provided, Dr. M. is unable to tell definitively if my wife's tubes are clear or not. He will likely want to conduct this test again to be sure there is no issue (this is one of those tests that is not required if IVF is deemed necessary, but as stated in yesterday's comments, Dr. M. seems to be questioning whether or not we even have to do IVF, thus his likelihood to repeat this test)

This is all very unfortunate, as my wife said the dye test was incredibly painful. After leaving the actual procedure, she was very happy it was over - upon hearing Dr. M. state that we might have to repeat, she became afraid. One final thing on this dye test ... when we did the procedure IVF Michigan referred us to St. Joseph Hospital in Ypsilanti. The insurance my wife had at the time did not cover procedures out of St. Joe's - I understand there is another clinic that we could have been referred to that DOES accept my wife's insurance. It would have been very easy for the IVF Michigan staff to look at her insurance and refer us to a clinic that accepted it, but they did not do this. I guess it is our responsibility to check on these sorts of things, but we didn't learn about the insurance incompatibility issue until the day of the procedure. Given that there was ~1 month lead time to schedule this procedure, we decided just to go ahead and pay out of pocket. The grand total was just under $1,000 ... an expense that could have been avoided if we had done our homework and checked on the insurance accepted at St. Joe's, or even better, if the medical receptionists in IVF Michigan's Ann Arbor office would have taken 5 minutes to help us out. This is not the first time I've been burned by this - so shame on me I guess, but I'm still pissed at the receptionists for not helping us out on this one. I'll give them the benefit of the doubt and assume they are capable of more than answering phones and filing papers ...

All of these little oversights have instilled in me a deep sense of distrust for Doctors and medical receptionists. You can't be sure they will do anything for you ... no matter how much of a pain in the ass it is, or how irritating you might be to the medical receptionists for second guessing each of their moves, you always have to take matters into your own hands to ensure these things are done correctly or you will be stuck holding the bill for something that should have been covered by your insurance.

I'm off for the holidays - nothing new going on other than procreation in hopes of achieving a pregnancy via natural means (imagine that) ... hopes aren't high on this front, but it's worth a shot.

Tuesday, December 18, 2007

Today I'll address bullets 2 and 3 from our discussion with Dr. M., contrasting his opinion with that of Dr. S. - it's sort of like a boxing match between two heavyweight fighters ... if they had a physical fight, my money's on S. (he's younger, and appears to be more agile ... and Dr. M's weak handshake may be correlated to a lack of overall physical strength)

Post Coital Test

Next bullet on the list of concerns from our discussion with Dr. M. is Post Coital testing. According to my shallow understanding, this procedure assesses my wife's cervical mucus to determine if it offers a hospitable medium for the migration of my sperm to her egg. Sometimes the cervical mucus kills the sperm, making it impossible for them to reach the egg alive, thereby mitigating the chances of pregnancy. This is a test we bypassed during our first round of IVF with Dr. S. If our first round had worked, we would have been none the wiser for bypassing this test. Given that IVF didn't work, however, we now have to retrace our footsteps picking up the missing piece of information we skipped the first time.

The test requires us to have intercourse (yes!), my wife to lay down for one hour (which will be hard because she will probably have to pee), and for her to go into the office the following morning. They will pull a sample of mucus from her cervix and observe it under a microscope to see if there are living, swimming sperm in it. If there are, this is a good sign and indicates there are no issues with her cervical mucus. If there are dead sperm, then we have a problem - I'm not sure what steps are required to get around it, but I would guess they are pretty straight forward.

No Pill In Following Month

This one really burns us up. In a previous post, I cited some comments from the OBGYN Doctor my mother-in-law works for on the topic of achieving pregnancy in the month following IVF. Dr. M. echoed these sentiments exactly in yesterday's meeting when he said that he has data showing an increased likelihood of pregnancy for infertile couples in the 3 months following IVF! Given that Dr. S. placed my wife on birth control immediately after our failed cycle, we completely missed the chance to cash in on this statistical opportunity! We could get into some discussion of incentives of infertility doctors and how they are somewhat misaligned with the goals of their patients, but I'll assume that these doctors operate ethically. Dr. M. recommended that my wife cease consumption of the birth control pill and that we get busy "trying" as our window of opportunity is not completely exhausted (although 2 of 3 months are gone) Again, Dr. S. and Dr. M. offer completely opposing assessments on this aspect of infertility!

So, there you have bullets 2 & 3 - the 4th and final bullet will be revealed tomorrow (it's nothing big, so don't expect a major revelation ...)

Monday, December 17, 2007

A very fitting title for our meeting with Dr. Mthis morning on the topic of second opinions. Where to begin ... ah, let me consult the business card in my suit pocket upon which I jotted down a few key points of disagreement between Dr. M and Dr. S. - before diving in, a little background (just the facts):

We conducted our first, unsuccessful round with Dr. S. at IVF Michigan in October 2007. As a result of many frustrations with the process at IVF Michigan, the details of which I have only touched on in previous posts, we decided to seek a second opinion from Dr. M of Oakwood Hospital (the SART data shows Oakwood to be the second largest clinic in Southeast Michigan, by # of cycles, and it is in Dearborn, where my wife works) I dropped off our files with Dr. M a week prior to our meeting so he could see where we've been, and hopefully formulate a preliminary prognosis.

We were greeted by a pregnant medical receptionist, which was a double-edged sword: My wife wasn't pleased that this girl was pregnant (the sharper of the two edges), but there was the off chance that she became that way through the services of Dr. M (an unlikely scenario, but the more preferred of the two offered) We were escorted to Dr. M's office, down a hallway covered with baby photos, where we sat for about 15 minutes looking at some flip books of mis-shapen sperm and uterine maladies. Mis-shapen sperm, for those of you who don't know, look pretty messed up (two heads, two tails, big heads, small heads, pointy heads, etc.) Scary stuff ... makes you glad you're not an egg and that you don't have to deal with these monsters viciously swimming into your sides trying to penetrate your skin. Dr. M. greeted us with a very soft hand shake, almost as if to say "Hello. I'm a gentle man and intend to treat you as such through this difficult time." He took a seat across the desk from us and his assistant assumed a position next to him (a female Doctor, whose name I don't remember) He first asked us if we had any questions for him. What a nice start! Dr. S. always rambled on for a few minutes, before finally saying "Now I am open to answer any questions you might have." We told Dr. M that we primarily wanted to focus on our first procedure, his assessment of our files and how we might adjust course in round two. From here I will follow my bulleted list from the business card upon which I took notes - each bullet highlights a key difference between Dr. M's remarks and what was done at IVF Michigan by Dr. S. There are 4 bullets in total - I will elaborate on one bullet per day (assuming sufficient time to write, which shouldn't be a problem as it's the week before Christmas and productivity in the U.S. economy is as an all time low - an unsubstantiated theory)"Sperm Morph + Volumes = No Problem!"

Dr. M. started by commenting on the fact that our files indicated a theme of male factor infertility, due to morphology issues. He then did some high-level math on a pad of paper using the sperm count + morphology formula to show that he had a different opinion of said diagnosis. Apparently my counts are very high (hell yeah!), but my morphology is poor ( ... ) When you combine my high sperm count with my low morphology, however, the net result is, according to Dr. M., a more than adequate amount of healthy sperm to achieve pregnancy. So, his opinion (based on data provided from 4 semen analyses) was that our issue is NOT with my sperm morphology. WTF?!?!? This is in direct contrast to the hypothesis upon which Dr. S. convinced us of the necessity to do ICSI! Dr. S. told us in convincing fashion that our problem was certainly due to morphology and that our best course of action would be to proceed with ICSI. So, here we have two Doctors in direct opposition to one another in their interpretations of a semen analysis report, which by my assessment, should be one of the more elementary pieces of information available to an infertility specialist. So, in a head-to-head comparison we felt more comfortable with Dr. M's diagnosis, but not because it is the preferred solution for my own male psyche but because the results of my semen analyses, in terms of providing a diagnosis for our inability to achieve pregnancy, are at best inconclusive - they don't tell you definitively that this is the single and only source of our problem, so therefore, IVF should not be recommended until further testing has been conducted.

Having started the meeting with Dr. M. on this note, my wife and I felt a slight sense of anger with Dr. S. (which would be the first of many during this meeting) but we also felt a sense of relief - we entered the meeting fully expecting to discuss our second round of ICSI, requiring the shifting of monetary funds, preparation for an emotionally charged start to 2008 and a great deal of angst throughout the holidays. That was not the case with Dr. M's ultimate diagnosis. In Dr. S's defense, we did have some further testing done during our first round of IVF, but the full suite of tests available to diagnose the root cause of infertility was not exhausted. This is essentially what Dr. M's final recommendation was - that we proceed through a methodical system of testing bypassed in round one to assess the true nature of our infertility issues. On this, I intend to elaborate in more detail during my remaining posts for this week with bullets 2 - 4.

Friday, December 14, 2007

My wife is having her period - thought you'd like to know that. I'm going to try blogging about it. I wonder how many blogs are written on the topic of periods ... written by guys.

What's weird is, she says she's particularly uncomfortable this month, and that there are a lot of "fleshy clumps" (nasty) ... this prompts a lot of thought. Perhaps the increased pain is due to the hearty uterine wall she built up in preparation for an implanted embryo (or two), and getting it out of there requires more wrenching of the uterus. The procedure failed two months ago, and she went on the pill right afterwards, so her last period was sort of screwed up. Maybe the purge was delayed by one month? Who knows ...

What if she was really pregnant and the tests didn't detect it and this is just a miscarriage? I doubt it, but wanted to say it anyways because I'm sure those of you who read this and have experienced something similar have thought the same thing.

In our next round we're going to ask the Doctor excruciatingly detailed questions about every phase of the process. In round one we often left our Doctor's office more confused than when we arrived - not good. This was probably 80% our fault, for not asking the right questions, but come on, we're human ... we don't always think of what to ask when we're sitting in front of a visibly busy, rushed Doctor. So, this time I've got to learn about my wife's period, amongst other things, so I can push the line of questioning with our Doctor until we feel comfortable and educated.

All's I know is my wife is very uncomfortable today, she's home from work with our puppy, who is probably peeing on the bed while biting her. Somehow I have to remember to get flowers on the way home.

Thursday, December 13, 2007

My wife can't figure out what to get me for Christmas, and I really can't give her any ideas since I already have everything I need or want. So, let's brainstorm ... and you IVF girls can probably use some of this for ideas for your husbands.

An ideally packed stocking, in my world, would contain:

-Kodiak (that's chewing tobacco for those of you not in the know)-Scotch (Obon, or a $50 - $100 bottle of anything else)-Cigars (I don't smoke them because of my asthma, but I wish -Snickers (arguably the best candy bar in production)-Gum (just to fill space, and to repair damage from Kodiak and Scotch)-Rubik's cube? (I just got one of these, but have enjoyed it immensely ... I'm sure a lot of other guys would too)-Nerf dart gun (to shoot dog with)-Nerf basketball hoop (no wife would allow their husband to put one of these up in the house, but it would be cool if they did)-Tickets to MSU basketball game (or alma mater of your choice)-One free pass to drop husband and his brother off at the bar, and pick up at closing time without commenting on stupid comments or scent of husband and brother, while promising to laugh at jokes-Nintendo Wii (these are impossible to find, and might make a tight fit in a stocking, but I want one ...)-Nintendo DS Lite (all guys should have one of these as there are a ton of old school games available for it ... and if they're embarrassed to say it, shame on them)

That's all I can think of ... apologies to my wife for a lack of ideas, but I'm sure she'll come up with something good - she always does.

Tuesday, December 11, 2007

Our first round of IVF cost us about $12,000. For us, that is a lot of money. Considering that most couples can achieve a pregnancy for free, this makes for 12,000 painful reminders of the situation we are in. It's hard not to wonder what might have been ... instead of IVF you could afford to buy (revealing some interests of my wife and I along the way):

I'm using my year end bonus and some of our savings to cover round 2, but to make up the difference we are making a number of other sacrifices. For starters we are going to defer purchase of new vehicles. I'm driving a 2001 Ford Explorer Sport, and my wife a 2004 Dodge Stratus. Both are decent vehicles that run well, but mine has over 100k miles on it and my wife's is pushing 40k. We could theoretically make it another 5 years before there is a need to purchase a new car. It would be nice to get something newer now, but we have financial realities to deal with.

We're continuing to max out our 401(k) and Roth IRAs. This slows down our rate of savings for other things, but in my book, these are absolutely essential investments that everyone should be making before anything else. Besides, we're young - we need to take advantage of these investments and the time we have between now and retirement to accrue some wealth ... and the fact that we are young gives us the privilege of time in achieving a pregnancy. The credit crunch, imploding housing market and (likely) impending recession are enough of a scare in the short run - I hate to think about those who are opting out of their 401(k) plans and foregoing all retirement savings in favor of covering short term expenditures, or to dig themselves out of the piles of debt they are in. You think things are bad now? Wait until all of these people who have opted out of retirement savings and have screwed themselves by taking on more debt than they can afford reach retirement and have nothing to fund their lifestyles ... there's another word that ends in "ession" that may be dusted off at that point in time. I hope to be living comfortably with my wife and child(ren) if / when that happens. Nothing elaborate ... just comfortable.

We're still Christmas shopping and trying to be generous in that regard - we have been blessed with great families, and want to ensure that we sacrifice nothing with them as they have been incredibly supportive throughout this process of infertility. I must say, however, that the expense of x-mas is a bit painful to endure, but we're looking forward to a nice Christmas with the families.

Friday, December 7, 2007

I just changed the title of this blog to "IVF - A Husband's Perspective" from "IVF - A Husband's In Vitro Perspective"

The original title was no attempt at being cute or anything like that ... it was sort of an oversight (I always intended to remove the "In Vitro" part, but never actually got around to it until today) The phrase "In Vitro" is Latin for "In Glass", and implies that something happens in an artificial environment. This whole process is, by my estimation, as close to an artificial environment as I've been in my life ... the whole thing is just so completely bizarre and surreal that there's no better way to describe it. Perhaps my original title was a worthy one ... but the words would've needed to be moved around because as it was, it was confusing and stupid. I'm going to leave it as you see it above from here on out - I've always been a believer in simple messages and efficient solutions ... my new title, in my opinion, is just that: Simple and to the point.

There is a bag on the workbench in our garage that contains a t-shirt. The t-shirt says "America's Next Top Mommy" The bag is a shipping bag and it sits exactly where it landed after being tossed by my wife the day we learned our first round of IVF had failed. Not sure if I'll ever move that bag for any reason other than changing oil in the car.

On an unrelated note, I'm starting to think about new years resolutions and our second round of IVF and how I might optimize my reforms by taking advantage of the overlapping objectives of each endeavor. These thoughts were prompted by another IVF blog from the male perspective in which the author described his Doctor's orders to abstain completely from caffeine, and limit alcohol intake to less than 2 drinks per week. Now, this conflicts with what we were told by Dr. S.- I asked about both substances, and how I should impede my enjoyment of them during the build up to our first round. He very casually replied that it would be okay to have a few drinks each week, so long as I didn't over do it (didn't specify "not to exceed" volume) and he actually encouraged me to drink caffeine, saying it was good for sperm (according to some study they did) My issue is with morphology, not counts or motility - perhaps this is why he didn't discourage me to partake of the substances (perhaps they have no detrimental effect on shape?) Either way, it was all very casual and ad hoc, leaving me with the feeling that the quantity of these two inputs would have little effect on the outcome of our procedure. So, I commenced with partaking in drink, but not to the point of excess. I did, however, drink a lot of coffee as the 12 hour days require it ... I'm still drinking a Venti coffee each morning and a double shot of espresso in the afternoons. If I need to quit this stuff, I need to do it soon so I can detox my system prior to leaving my sample for round 2. Perhaps I should just do it anyways, prior to receiving word from the Doctor?

Either way, I'm hoping that our next round includes some specific directions on how much (not) to drink, whether or not to drink caffeine, any vitamins I should or should not take, etc. Even if the Doctors don't have an indication on specific volumetric measurements that should be undercut, I would still like absolute, crystal clear direction from them on every variable that could impact our chances at achieving pregnancy. If they prescribe our lifestyle in such a way, at will at least be able to take solace in the fact that I have controlled those things that I could to the best of my ability.

Nothing on tap for the weekend other than a bottle of wine with my wife tonight over dinner - I can't wait ... feels like we haven't spent any time together in several weeks. I miss her very much.

Thursday, December 6, 2007

Tonight is my wife's work party ... I was supposed to go, but we got a call today for a showing on our house tomorrow morning, so now I'll spend the night cleaning and prepping our home (perhaps we'll get a bid?) As noted in an earlier post, our home is on the market, and the activity has been very slow. Each of the showings we've had to date has brought with it a great deal of optimism, excitement and teasing hopes that we might actually sell our house and move up North. So, this is our first showing in over 3 weeks ... we have to make it count, so I get to clean.

My wife and I used to wake up on Saturday mornings, drink coffee and spend about 2 hours in an all out joint cleaning effort prior to going about our days. My job was to dust, vacuum, wipe down stainless steel appliances, swiffer and organize while my wife cleaned bathrooms, put away laundry, cleaned the kitchen and whatever other tasks remained. This was a great system - my wife and I both appreciate a clean house, and neither of us really mind cleaning all that much, so this was a fairly enjoyable routine. That all changed when we got our puppy. Since my wife will be at her work party I will assume full responsibility for prepping our home for tomorrow's showing. I'm already nervous about how I'm going to get all of this cleaning done tonight while simultaneously watching our puppy ... anyhow, this prompts some thoughts on puppy rearing vs. child rearing.

Our puppy demands 100% of our attention ... look away for more than 10 seconds and he'll start chewing on cords, eating the Christmas tree or biting your feet. Then you have to bring him outside every 20 minutes so he can do his business (we estimate we brought him outside over 40 times last Sunday) He cries at night, and we have to bring him outside every 4 hours or he'll make a mess in his crate (and eat the evidence) This is all a lot of work, but it is very much worth it when he falls asleep on your lap, or tries to sleep as close to you as he can. He's a cute little guy, especially when he's sleeping, is very affectionate and very dependent on us for everything. Most importantly, he has diverted our attention from infertility to something else ... and he makes us laugh.

A baby, by my estimation, would require a similar amount of work ... I would even guess that it would be LESS work, at first. A baby sleeps more, can be left alone in a swing or baby seat for a few minutes here and there, does its business in the house (in its clothes), goes to bed early and doesn't bite. Either way, this puppy has opened our eyes just a little to how our lives will change when our parenting days begin. If we had not failed our first IVF cycle, we would not have gotten this puppy ... I shudder to think that Cooper might have ended up with some Amish family, forced to pull a plow through fields, or churn butter all day. Perhaps we needed the primer on parenting offered by puppy rearing prior to getting into the game of parenting human children. I've always heard people say that your priorities change the second you become a parent. I'm attached to my little puppy, but nowhere near what I will be to the baby we will one day have (our own, or adopted), but I can say my priorities have changed a little bit ... that small amount of attachment between me and the dog, however, has been insightful into what I expect the world of parenting to be like.

Anyways, if there are pools of blood lying around on this blog tomorrow, please don't be alarmed - it will likely be falling out of the holes Cooper will put in my body tonight while I clean. Hopefully these people will buy our house ... we need a break, and a bid would be a very welcomed one.

FYI - Prior to owning a dog I would have read this and said: Bullshit ... I feel a little differently about things now.

Wednesday, December 5, 2007

Just made our appointment for round two, with Dr. M. at Oakwood Hospital (technically, the clinic is called "Center for Reproductive Medicine Oakwood Hospital and Medical Center" - ironically, this is where I went for my first and second semen analysis ... when I left there last time I thought "At least I'll never see these people again!" ... how fate plays tricks on us)

Our appointment is scheduled for December 17th, so expect a report out on the 18th of what our second round will hold for us. I'm guessing it will involve shots in the leg, shots in the ass and more "doing it" with cups. Once again I'm reminded of my position in this whole thing - the receptionist made it clear that they would be "treating" my wife while I get to skate with little to no responsibility. My poor wife. She has been through so much in the past year. Our puppy hasn't made it much easier. While I'm out "consulting", getting home at 8 p.m. every night, she's dealing with all of Cooper's sharp teeth and pent up energy from spending the day in the bathroom playing with / eating his own turds. I appreciate her and everything she's going through more than she will ever know.

Oh, to top it all off, we just received an e-mail from one of my wife's cousins with subject "Coming June 2008 ..." Inside were four ultrasound photos of their baby, which is currently being assembled inside of his wife's womb. From what we know they didn't have to pay anything for this to happen, didn't have to take shots, didn't have to take the eggs out of her body and then put them back in again or anything. We're happy for them, obviously, but it's another reminder of our situation. Even better, this morning while I was filling my gas tank I saw this sign on the gas pump that read as follows:

Children's are God's most precious gift. Please choose life.

Um - we're trying, like $10,000 - $20,000 hard, to choose life.

So anyways, we're going to commence planning for round two in just under two weeks. Actually, we're feeling pretty optimistic about our chances in round two - we just heard about another girl who successfully conceived on her 4th round of IVF. I hope it doesn't take us that long, but I do HOPE ...

Finally, I was impressed with Dr. M's receptionist. She even went so far to ask for the customer service number from my insurance provider so she could ensure our consultation will be covered. Those little things go such a long ways towards easing the process. I told her how impressed I was with the fact that she asked a question that all medical receptionists should ask, and that I appreciated it very much.